Non-South Africans are not entitled to the full package of comprehensive healthcare provided to this country’s citizens, the chairperson of Parliament’s Health Portfolio Committee has said, calling for urgent legislative reform to address the mounting disruptions by Operation Dudula activists.
Dr Sibongiseni Dhlomo's remarks come in the wake of Health Minister Aaron Motsoaledi’s warning to the vigilantes that legislation governing access to public health services will not be changed under pressure.
SowetanLIVE reports that Dhlomo was addressing committee members last Thursday after videos on social media showed Operation Dudula thugs preventing foreigners from entering clinics and some hospitals.
He added that foreign nationals are entitled only to emergency medical services – and, he remarked, government was considering certain legislation in this regard.
“Our Constitution… talks about South Africa belonging to all who live in it. That part is important and ought to be respected. But the conclusion from the National Health Insurance public hearings was that the country should provide emergency services to all – which means foreign nationals as well – so that is binding in terms of UN rules. But comprehensive healthcare is for South Africans,” he said.
However, he said, while migrants are not entitled to the full range of health services, Operation Dudula’s approach of stopping people from entering hospitals and clinics was not the right way to deal with the issue, and a “streamlined approach” was needed.
He said the Health Department has been “engaging the organisation and other stakeholders”, and that discussions had extended to Home Affairs, with proposals to review and possibly repeal sections of key legislation such as the South African Citizenship Act, the Refugees Act, the Identification Act and the Immigration Act.
“Some of these Acts are wide and encompassing. Maybe they should have limitations. It’s not possible for us to have unlimited resources to deal with what is there,” he said.
Govern access
The portfolio committee was seeking “a more coherent legal framework to govern access … by the undocumented patients”, he added, citing vague definitions and overlapping provisions in existing legislation as contributing to administrative confusion and public frustration.
He also noted that many South Africans themselves remain undocumented, complicating efforts to distinguish between citizens and foreign nationals, reports BusinessLIVE.
According to estimates cited by the Department of Home Affairs, around 6m South Africans still lack formal identity documentation. Dhlomo also warned that any policy response must avoid penalising citizens who fall outside the formal registry.
“Minister Motsoaledi has taken the leadership of Dudula through the various policies and pieces of legislation that govern and regulate the provision of healthcare … which are beyond our control. As a department, we have to comply,” said Health Department spokesperson Foster Mohale.
Campaign percolated for months
The vigiantes have disrupted access to migrants seeking healthcare to at least 53 clinics in KwaZulu-Natal, Limpopo, Mpumalanga, Gauteng and the Eastern Cape, and with no clear interventions in place, vulnerable groups are left scrambling for life-saving healthcare.
While the targeted disruptions by these groups are not new and have been a longstanding concern for many human rights organisations, reports of the latest campaign began surfacing as early as June this year, reports Daily Maverick.
Médecins Sans Frontières (MSF) regional advocacy co-ordinator Clair Waterhouse said her organisation had tracked 15 clinics where Dudula members had been permanently stationed.
Contrary to claims that the disruptions target only illegal foreigners, the consequences are broader. People with valid work permits, permanent residence and even South African citizens have been refused care.
“Our observation shows very strongly that for migrants, it doesn’t matter if they are documented or not. We’ve seen people with South African IDs, valid visas, even passports, being told their documents are ‘not good enough’ and ordered to leave. South Africans who forget their IDs at home are also barred. We’ve even seen children and pregnant women denied care,” said Waterhouse.
Alarming cases
MSF teams on field assessments had witnessed alarming cases. In Johannesburg, a six-month-old baby with a severe respiratory infection was turned away. In other facilities, pregnant women were denied access to antenatal care.
One of the most disturbing trends MSF documented was collusion by health staff with the anti-migrant groups.
“At two clinics, the work of these groups was actively facilitated by either clinic security or staff themselves. We’ve even heard reports of nurses saying they are grateful, because it means fewer patients. In some cases, Dudula members told us they ‘check in’ with staff every morning as if they were part of the clinic’s routine,” she said.
Daily Maverick has extensively reported on the impact of these disruptions, from mothers unable to seek post-natal care, migrant parents being unable to access life-saving healthcare for their children, and injured people without documentation being turned away from clinics by Operation Dudula members.
Lack of urgency from State
Despite repeated appeals from MSF and the Treatment Action Campaign (TAC), the Department of Health has yet to issue a robust response. MSF’s Waterhouse confirmed that organisation had written to national and provincial authorities, sharing detailed concerns and even cases of collusion, but received no reply.
“We don’t believe this is being treated with the urgency it deserves,” she said. “What little has come out has not been sufficient. Seven weeks of significant blockages at health facilities is not acceptable.”
Daily Maverick asked the Department of Health for clarity on protocols to halt the disruptions, but no response had been received by the time of publication.
The TAC believes the silence reflects a deeper governance failure.
“The existence of legislation that guarantees healthcare to all means nothing if it is not enforced. We see police standing by without intervening. We see facility managers turning a blind eye. In practice, this amounts to condoning the violations,” TAC Gauteng provincial chairperson Monwabisi Mbasa said.
In the absence of decisive government action, civil society has moved to fill the gap. The TAC, long known for its grassroots fight for access to HIV and TB treatment, is now redirecting much of its energy to assist those excluded from healthcare by the Dudula disruptions.
“In just three weeks, we’ve helped more than 28 people access medication, and the number keeps growing daily. Recently, we received a list of 200 patients who had been completely turned away. They all needed urgent support to get treatment or medication, and without intervention, their lives would have been at serious risk,” Mbasa said.
The TAC operates through a network of local branches and volunteers. When a patient is denied care, the organisation steps in to connect them with comrades closer to alternative facilities, ensuring they can safely access treatment.
“We don’t want to tamper with the health system’s data, so we link patients directly to nearby facilities,” Mbasa said. “That way, treatment continues, and their medical information remains recorded in the system.”
Pregnant women denied access to viral load testing have faced the terrifying possibility of passing HIV on to their unborn children.
No law enforcement
Meanwhile, National Police Commissioner General Fannie Masemola has said that although Operation Dudula and March and March’s actions are unlawful, there is no specialised police unit dedicated to reining in their behaviour – or their restriction on undocumented foreigners accessing healthcare services, reports The Star.
Masemola told a media briefing in Pretoria that the Public Order Policing (POP) will intervene only if public disturbances occur, marking the first time he has publicly addressed the issue.
He said the job of a POP units was to deal with crowd management and public gatherings, major events and protests – although police, including some POP officers, have been deployed to some affected clinics to restore order.
“These POP units cannot wait at a clinic just in case something happens – they have a lot of other work to do,” he said.
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